Lord McFall of Alcluith: My Lords, on the costs, today I picked up with my mail a copy of the booklet entitled Restoration and Renewal Members’ FAQs. It contains 11 sections in total with 77 questions. If I recall correctly, the issue of costs is set out on page 12. Perhaps I may give your Lordships the costs for the House of Lords. To the end of quarter 3 of the 2014-15 financial year, the House of Lords had spent £28.2 million on capital costs and £18.4 million on resource costs. As far as the rest of the project is concerned, all that is laid out comprehensively on the same page.

Lord Stirrup: My Lords, much of the context for this debate is set by the targets that NHS England has laid down for the delivery of its services. There has been much discussion of the appropriateness of these targets, but we can draw some general conclusions from the persistent failure of the NHS to meet them. I suggest that the most important conclusion is that we are looking at a system stressed beyond its capacity to adapt and at serious risk of catastrophic failure. One can cite specific weaknesses and institutional failings, an inadequacy of funding and the need for coherence across the care sector. All are valid points, but they miss the root cause of the extreme stresses in the NHS: there is no proper strategy for the provision of healthcare in England.
I say that because a proper strategy is not just about plans, nor just about resources; it is about balancing ends, ways and means. Part of that balancing act involves deciding on the ends that are achievable within the means available. That is the calculation missing today. We are simply asking too much of the NHS. This is not a problem that can be solved just by looking at the inputs. Healthcare is an inherently ungovernable system of ever-increasing demand and ever-increasing technological opportunities. The recent growth in pressure has already outstripped the new resources promised, but that is not surprising. Left to itself, demand will always exceed supply, wherever we set the level of funding. We have to exercise control over the outputs as well as the inputs. That involves making hard choices and taking political risks, which is why I am rather pessimistic about the likelihood of our grasping this nettle. I do not believe that any of the main  political parties is courageous enough, but we should be under no illusion about the consequences if we fail to rise to the challenge.
The Government will point to their long-term plan and the proposed increases in the numbers of clinical staff. These are indeed welcome, but they are insufficient. The Minister will be aware that morale within the NHS is in a parlous state. Many clinical staff are exhausted, physically by the unrelenting demands placed on them but also, and perhaps more importantly, exhausted mentally because they see no light at the end of the tunnel; indeed, they see no end to the tunnel. They need some sense that the system will be brought into sustainable balance in the reasonably near future, but I fear they are unlikely to receive such reassurance. If that is so, I ask the Minister to respond to some more detailed concerns, which, if addressed, might at least help to stave off an impending collapse of the service.
NHS staff clearly need some immediate relief from the pressures under which they labour today. The Interim NHS People Plan has made some proposals in this regard, but a number are as yet neither specific nor quantifiable, so when will a comprehensive and detailed plan of action, with milestones and accountable persons, be available? How will progress on these measures and their impact on NHS morale be assessed and reported?
At present there is a clear lack of adequate or timely maintenance of the NHS infrastructure, which—as we know only too well in this place—only builds up even greater and more expensive problems for the future. What steps are being taken to improve and sustain the fabric of the NHS estate, and how are capital investment and maintenance needs being measured, funded and reported?
The pressures on GPs mean that all too often they are unable to investigate the condition of their patients as thoroughly or deeply as they would like. This can result in them making more referrals than necessary to a secondary care specialist, leading to longer waiting times for all. A little more investment in the primary care end of the spectrum might result in an overall saving of time, money and staff morale, as well as a better service to the patient. Can the Minister say who, if anybody, is making such risk/benefit judgments, especially across the boundaries in the care system, and what power they have to allocate resources in ways that would give effect to such judgments?
The Prime Minister has indicated his intention to seek a consensual way forward on adult social care. My plea, echoing the noble Lord, Lord Bates, is that this be extended to the provision of care more widely, to include the NHS. The Beveridge report and the ensuing legislation to give effect to it were made possible perhaps only by the upheaval and dislocation of a catastrophic world war. I hope we do not have to experience similar turmoil before we can make Beveridge’s legacy fit to survive the challenges of the 21st century.